Healthcare Provider Details

I. General information

NPI: 1821317173
Provider Name (Legal Business Name): THINK,DREAM,LIVE FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 RALPH DAVID ABERNATHY BLVD SW
ATLANTA GA
30310-1753
US

IV. Provider business mailing address

1285 RALPH DAVID ABERNATHY BLVD SW
ATLANTA GA
30310-1753
US

V. Phone/Fax

Practice location:
  • Phone: 678-558-2684
  • Fax:
Mailing address:
  • Phone: 678-558-2684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateGA

VIII. Authorized Official

Name: MR. JOHARI DOZIER
Title or Position: FOUNDER/CEO
Credential:
Phone: 678-558-2684